持续缓慢低效血液透析和连续静脉静脉血液滤过的对照研究

Comparative study between sustained low-efficiency hemodialysis and continuous venovenous hemofiltration

目的比较单次持续缓慢低效血液透析(SLED)和连续静脉静脉血液滤过(CVVH) 对重症急、慢性肾衰竭(ARF、CRF)患者的疗效及其血流动力学变化。方法14例重症ARF、CRF患者随机接受SLED、CVVH治疗各10 h。测定治疗前后血电解质、肾功能、白介素6(IL-6)、β2微球蛋白(β2-MG)水平,治疗后1 h BUN、置换液和透出液尿素氮水平。计算溶质清除指数(SRI)、IL-6下降率、β2-MG下降率、血磷下降率。记录超滤量和治疗中血压等临床指标变化。结果14例患者均无失衡反应及严重低血压发生,无电解质紊乱,无血液净化相关性死亡。CVVH组:平均超滤量(3.30±1.95)L,SRI为(39.97±15.29)%,IL-6的下降率为(-22.81±85.30)%; β2-MG下降率为(35.01±24.83)%,血磷下降率为(24.40±23.20)%。SLED组:平均超滤量(5.40±2.96)L,明显高于CVVH组(P<0.05);一过性低血压发生率5/14,与CVVH组无显著性差异(P>0.05);SRI为(72.27±9.71)%,比CVVH组明显升高(P<0.01);IL-6下降率为(-32.86±63.68)%,与CVVH组比较无显著性差异(P>0.05);β2-MG下降率为(39.97±15.29)%,与CVVH 组比较无显著性差异(P>0.05);血磷下降率为(49.23±18.61)%,明显高于CVVH组(P<0.01)。结论SLED血流动力学稳定,对低分子毒素的清除较CVVH组高。SLED是治疗重症ARF。

Objective To compare the therapeutic efficiency and hemodynamic changes on severe acute or chronic renal failure patients between sustained low-efficiency hemodialysis (SLED) and continuous venovenous hemofiltration (CVVH).Methods Fourteen cases with severe acute or chronic renal failure received randomly CVVH and SLED for 10 hours respectively: Washout period was set for 24 hours. Pre- and post-treatment blood electrolyte, IL-6, β2-MG, post-treatment 1 hour serum BUN, waste dialysate urea were measured. Solute removal index (SRI), IL-6 reducing rate, β2-MG reducing rate, serum phosphate reducing rate were calculated. Ultrafiltration (UF) quantity, blood pressure, and other clinical symptoms during the treatment were recorded. Results No disequilibrium, no severe hypotension, no electrolyte disorder, and no blood purification relevant death were found in 14 patients. IN CVVH group, average prescription UF quantity was(3.30±1.95) L; temporary hypotension incidence was 4/14; SRI was (39.97±15.29) %; IL-6 reducing rate was (-22.81±85.30)%; β2-MG reducing rate was (35.01 ±24.83)%; phosphate reducing rate was (24.40± 23.20)%.In SLED group, average prescription UF quantity was(5.40±2.96)L, significantly higher than CVVH (P < 0.05); temporary hypotension incidence was 5/14, not different from CVVH (P > 0.05) ; SRI was (72.27±9.71)%, significantly higher than CVVH; IL-6 reducing rate was (-32.86± 63.68)%, not significant from CVVH(P> 0.05); β2-MG reducing rate was (39.97±15.29)% , not different from CVVH (P>0.05); phosphate reducing rate was (49.23±18.61) %,significantly higher than CVVH(P<0.01). Conclusion SLED has stable hemodynamics and better removal of blood low molecular solute in severe renal failure patients than CVVH,which is a new effective renal replacement method, offering another one choice for severe renal failure patients.